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Nsg 200 > mobility and musculoskeletal > Flashcards

mobility and musculoskeletal Flashcards

1
Q

what is the function of the bones

A

red blood cell formation, structure, movement

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2
Q

how many bones are in the body?

A

206

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3
Q

what are the two types of bones

A

compact and spongy

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4
Q

compact bone

A

forms the shaft and outer layer of bone

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5
Q

spongy bone

A

Spongy bones – has
spaces / ends and
centers of bones
* Red marrow produces
blood cells
* Yellow marrow
composed most of fat

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6
Q

axial skeleton

A

head, neck, trunk spinal cord, and ribs

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7
Q

appendicular skeleton

A

hips, legs and arms

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8
Q

the three types of muscle

A

– Skeletal- under conscious control
– Smooth- organs and tissues under unconscious control
– Cardiac- heart

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9
Q

what attaches muscle to bone

A
  • Skeletal muscles attach to bones by
    way of tendons. These muscles allow
    the body to move.
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10
Q

what attaches bone to bone

A

ligaments

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11
Q

abduction

A

moving away from the midline

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12
Q

adduction

A

moving towards the midline

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13
Q

flexion

A

decreasing the angle of the joint

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14
Q

extension

A

increasing the angle of the joint

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15
Q

supination

A

palms facing up

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16
Q

pronation

A

palms facing down

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17
Q

circumduction

A

moving in a circle

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18
Q

what are the three types joint

A
  • Fibrous- immovable (skull bones)
  • Cartilaginous – partially movable (vertebrae)
  • Synovial – freely movable and joined by ligaments (hip)
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19
Q

fibrous joint

A

skull bones

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20
Q

cartilagenous joints

A

vertebrae

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21
Q

synovial joint

A

freely movable and joined by ligaments, hip, shoulder, knee

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22
Q

joints are covered with

A

– Covered with articular cartilage to protect the bone: allowing the
bones to slide over one another

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23
Q

what other joints are also synovial

A

hips, knee, shoulder, wrist, elbow, thumb

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24
Q

what questions would you ask to gather subjective data

A

Any pain
Level of movement
Stiffness
Use COLDSPA

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25
Q

ask questions of recent weight gain and pain

A

Why are they here?
Recent weight gain? Weight gain can increase physical stress and strain
Pain or tenderness? Bone pain can be dull/deep
Joint or muscle pain can be aching

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26
Q

when did the pain start

A

When did it start?
What does the pain feel like? Sharp, stabbing, aching
Was there an injury? Fractures increased pain with movement and usually sharp pain

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27
Q

Personal health history
Any previous injuries to joints, muscles, bones? What treatment?

A

Use of
corticosteroids causes decreased bone density.

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28
Q

when was your last tetanus and polio vaccine

A

Joint stiffening can occur in tetanus/polio

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29
Q

previous MS diagnosis

A

Diabetes, lupus, osteoporosis

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30
Q

menopause ?

A

Menopause? (For middle aged women) – decreased estrogen levels lead to decrease
bone density = increased risk of osteoporosis

31
Q

activity level and medication use

A

Activity level? Activity promotes health of MS system
Medications? Some medications can alter MS function
diuretics-alter electrolytes = muscle weakness
steroids – deplete bone mass,

32
Q

smoking and alcohol use

A

Smoking /alcohol use? Smoking and alcohol use risk of
osteoporosis
Occupation, Leisure activities, ADL’s, stress

33
Q

Is the following statement true or
false?
Decreased estrogen levels after
menopause increase the risk of
osteoporosis.

A

TRUE

34
Q

Gait and posture: manner
of walking

A

Gait is the first assessment
completed for a
musculoskeletal assessment
assess for risk of falling –
always protect the patient
Observe posture standing
with feet together and sitting
– is weight evenly
distributed? Do they have
abnormal curvature?
observe gait – is weight
evenly distributed? Are
movements coordinated?

35
Q

Temporomandibular joint:

A

Inspect and palpate the TMJ
– place index and middle
fingers anterior to the ear
opening. Ask client to open
and close mouth. Fingers
should drop into open space.
Test range of motion - open
and close mouth / bite down
Grating or crepitus can
signal TMJ dysfunction
Assess for difficulty chewing
– is grating or crepitus noted

36
Q

sternoclavicular joint

A

look for swelling, masses
Palpate for tenderness

37
Q

collecting objective data of the spine

A

– Observe the cervical, thoracic, lumbar curves.
– Palpate the spinous processes and paravertebral muscles for tenderness or
pain.
– Test ROM of the cervical, thoracic, lumbar spine.
– Test for back and leg pain.

38
Q

what test would you perform when a patient has back pain

A

lasegues test
Lay patient flat on their back and raise one leg up with knee straight. If
patient experiences sciatic pain when leg is lifted there is a suspicion for a
herniated lumbar disc.

39
Q

a patient presents with a fever head and neck pain and chills what do illness do you think the patient has contracted?

A

Impaired ROM and neck pain with fever/chills/headache can indicated
meningitis! This is a serious and often lethal infection!

40
Q

TMJ dysfunction

A

Palpate by placing index and middle finger just anterior to the
external ear opening, client opens mouth wide
– ROM: Client able to move jaw laterally against resistance.
Clenching teeth causes contraction of the temporal and masseter
muscles (no pain or spasms should be present)
– TMJ dysfunction: pain in the jaw joint and muscles that control jaw
movement
* Clicking sound or grating sensation when mouth open or chewing

41
Q

COLLECTION OF
OBJECTIVE DATA:
SHOULDERS AND
ARMS

A

– inspection – symmetry, color, swelling
– Palpate – tenderness or masses
– ROM – abduction, adduction, flexion
and extension, internal and external
rotation

42
Q

COLLECTION OF
OBJECTIVE DATA:
ELBOWS

A

– Inspect for size, shape, deformities,
redness, or swelling.
– Test ROM. – flexion / extension /
supination / pronation

43
Q

COLLECTION OF
OBJECTIVE DATA:
WRIST

A
  • Inspection – shape, symmetry, color,
    swelling
  • Palpate – tenderness in wrist or
    fingers
  • ROM – flexion (bend wrist down)
    /extension (bend wrist up) / spread
    fingers apart
  • Swelling can indicate rheumatoid
    arthritis
  • Non-tender round mass may be a
    ganglion cyst
44
Q

what is the phalen test

A

– Place back of hands together while flexing wrists 90 degrees and
fingers pointed downward. Hold for 60 seconds.
* No numbness or tingling = normal
* Tingling, numbness, burning = carpal tunnel is suspected

45
Q

what is the tinnel sign

A

Use your finger to lightly percuss over
the median nerve (inner aspect of the
wrist). Tingling of shocking sensation
is + sign for carpal tunnel syndrome.
This test has a high false-positive
rate.

46
Q

collection of objective data the hands and fingers

A
  • Flexion & Extension
  • Abduction & adduction
  • Opposition
47
Q

collection of objective data hips

A

Do not test ROM in a
patient that has had a
hip replacement!!!!!
– inspection-
buttock symmetry,
hips appear stable
– Palpate- non-
tender without
crepitus (grating,
cracking or
popping sound)
– ROM and strength

48
Q

collection of objective data knees

A

– Inspection – size, shape, symmetry
* Swelling near patella may indicate
fluid in the joint
– Palpate – tenderness, masses, swelling
* If swelling present, perform the
bulge test (with client supine use
the ball of your hand to stroke
medial side of knee upward 3-4
times to displace any accumulated
fluid. Next, on the lateral side of
the knee and look for a bulge on
the medial side. + bulge = joint
effusion (fluid)
* Tenderness and warmth may
indicate synovitis (inflammation of
synovial membrane)
– ROM – flexion, extension, walking

49
Q

collection of objective data feet

A

– Inspect position, alignment,
shape, and skin.
– Palpate ankles and feet for
tenderness, heat, swelling, or
nodules.
– Test ROM. Dorsiflexion, Plantar
flexion, Inversion, Eversion,
Abduction, Adduction

50
Q

locate these pulses

A
  • Carotid
  • Brachial
  • Radial
  • Ulnar-may be difficult to palpate
  • Femoral
  • Popliteal -may be difficult to palpate
  • Posterior Tibial
  • Dorsalis Pedis
51
Q

what are the 5 P’s for neurovascular assessment

A

pain, pulse, parasthesia, pallor, pain

52
Q

what are the abnormal spinal curvatures

A
  • Kyphosis –
    rounded thoracic
  • Lumbar lordosis –
    over rounding
    lumbar
  • Scoliosis –
    curvature of spine
53
Q

rheumatoid arthritis

A
  • Acute rheumatoid arthritis –
    tender, painful, swollen, stiff
    joints
  • Pain may be described as
    burning or throbbing which
    worsens with long periods of
    sitting/rest
  • Burning or throbbing on BOTH
    sides of the body
  • Stiffness in the joints that
    persists for at least an hour
  • Chronic rheumatoid arthritis –
    chronic swelling and thickening
    of phalangeal joints, limited
    ROM and finger deviation
54
Q

osteoarthritis

A
  • A CHRONIC disease in the joints
  • Decreased ROM, swelling, tenderness or crepitus may be seen
  • Pain usually occurs with one set of joints on ONE side of the
    body- pain is “deep in the joint”
  • Pain improves with rest and worsens in rain (perhaps a
    sensation of bones grating together), stiffness early in the
    morning that improves with movement
  • Decreased muscles strength
55
Q

osteoporosis

A
  • One in three women and one in five men will have a fractured
    bone, with hip, forearm, and vertebral fractures predominating.
  • Osteoporosis is lowest in black males and highest in white
    females.
  • Smoking puts patients at higher risk of osteoporosis!
  • Medications can put patients at higher risk of fractures
    – Corticosteroids (prednisone, cortisone)
    – Cancer medications (methotrexate)
    – Diuretics (Furosemide)
    – Antacids that contain aluminum
56
Q

how to control osteoporosis

A

Uncontrollable risk factors:
– Age, gender, family history, previous fracture, ethnicity,
menopause/hysterectomy
– Caucasian women are a high-risk group for osteoporosis!
Modifiable risk factors:
– Alcohol, smoking, low body mass index, poor nutrition,
vitamin D deficiency, eating disorders, low dietary calcium
intake, insufficient exercise (sedentary lifestyle), frequent
falls

57
Q

how to prevent risk factors for osteoporosis

A

1
Ensure a
nutritious
diet with
adequate
calcium
intake.
2
Avoid protein
malnutrition
and
undernutritio
n.
3
Maintain an
adequate
supply of
vitamin D.
4
Participate in
regular
physical
activity.
5
Avoid the
effects of
second-hand
smoke.

58
Q

gouty arthritis

A

great toe is
tender, painful, swollen, red
and hot

59
Q

callus

A

non-painful,
thickened skin

60
Q

corn

A

painful thickened skin
over bony prominences /
pressure points

61
Q

plantar warts

A

painful thickened skin
over bony prominences /
pressure points

62
Q

is the following statement true or false?

Calluses are painful
thickenings of the skin
that occur over bony
prominences and at
pressure points.

A

FALSE

63
Q

considerations in older clients

A
  • Older clients usually have slower movements,
    reduced flexibility, and decreased muscle
    strength because of age-related muscle fiber
    and joint degeneration, reduced elasticity of
    the tendons, and joint capsule calcification.
  • An exaggerated thoracic curve (kyphosis) is
    common with aging.
  • Bones lose their density with age, putting the
    older client at risk for bone fractures,
    especially of the wrists, hips, and vertebrae.
  • Joint-stiffening conditions may be
    misdiagnosed as arthritis, especially in the
    older adult.
  • Osteoporosis is more common as a person
    ages because bone resorption increases,
    calcium absorption decreases, and production
    of osteoblasts decreases as well.
  • Some older clients have an impaired sense of
    position in space, which may contribute to the
    risks of falling.
64
Q

considerations of the pregnant client

A
  • Realignment of spinal curve due to increase in size
    of uterus. This gives the patient a “waddling gait”.
  • Increased mobility of the pelvic joints to allow for
    stretching.
    – Gynecoid pelvis
  • Stretched and weakened muscles of the back and
    abdomen.
  • Center of gravity shifts forward.
  • Results in increased back and pelvic pain as well as an
    increase in risk of falling.
65
Q

ortolani maneuver

A

flex infant’s knees and
abduct legs moving knees outward and down –
clicking signifies possible hip dysplasia (femur
slipping in and out).

66
Q

barlow sign

A

flex infants knees and adduct legs
– feeling of head of femur slipping is positive
sign of hip dysplasia

67
Q

spina bifida

A

incomplete closing of the neural tube,
of the spinal cord. Defect can range from minor to
severe disability.

68
Q

the shape of the spine in infants

A

The spine has a single C-shaped curve in infants
under 3 months old.

69
Q

gena valgum

A

knock knees

70
Q

gena varum

A

bowed legs

71
Q

considerations in children and adolescents

A

Observe gait as the child enters the room.
* Rapid bone growth in infancy and
adolescence
* Bones increase in circumference and length
under the influence of hormones
* Muscle Growth is related to the growth of the
underlying bone
* This age group is suspectable to
trauma/musculoskeletal injury
* Genu varum (bowed legs)
* Genu Valgum (knock knees)
* “toeing in” or “toeing out” indicates such
problems as tibial torsion or club foot
* Inadequate muscle size and strength for the
particular age may indicate neuromuscular
disorder (ie. Muscular dystrophy)

72
Q

when are screenings for scoliosis done

A

School screenings for scoliosis are usually completed between the ages of 10-14. This is done by having the client bend forward at the waist and assessing the curvature of the spine

73
Q

lifestyle and health practices for children and adolescents

A
  • Monitor for frequent fractures, as this may be a sign of abuse or a disorder of the Musculoskeletal system
  • Provide appropriate client teaching about safety and protective gear (i.e., sports gear)
  • School screenings for scoliosis are usually completed between the ages of 10-14. This is done by having the client bend forward at the waist and assessing the curvature of the spine
  • Proper nutrition is necessary for healthy growth and development
  • Childhood obesity is a serious problem in the U.S. and is associated with significant health risks
  • It is important to educate parents as well as children & adolescents on proper nutrition and calorie intake
    – A balanced diet
  • Adolescents is an important time when milk (calcium) and protein are needed to aid in bone and muscle growth
    – Common dietary deficiencies include iron, folate and zinc
  • Play, activity and exercise patterns can give the nurse valuable clues about a child’s overall health and allows the examiner to provide health promotion teaching

Nsg 200 (9 decks)

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